SME Denial Management Zapare Technologies Pvt Ltd

2.0 - 6.0 years

0 Lacs

thrissur, kerala

On-site

As an SME in Denial Management with 2-3 years of experience, you will be a part of Zapare Technologies Pvt. Ltd., a leading provider of Revenue Cycle Management (RCM) solutions for the US Healthcare industry. Your role will involve analyzing, managing, and resolving denied insurance claims to enhance collections and optimize revenue cycles for clients. Your main responsibilities will include developing and maintaining denial logs to identify trends, working with denial reason codes to take appropriate actions, and ensuring compliance with HIPAA, CMS guidelines, and coding standards. You will also manage the appeals process by understanding appeal processes and SOPs, preparing and submitting appeals with accurate documentation, and monitoring deadlines for timely submissions. The ideal candidate will possess a strong understanding of the US healthcare billing cycle, hands-on experience with EMR/EHR systems, in-depth knowledge of billing regulations, coding standards, and compliance frameworks. If you are passionate about healthcare revenue management and proficient in resolving complex denials, we encourage you to apply and be a part of the Zapare team. #Hiring #DenialManagement #RCM #HealthcareJobs #MedicalBilling #RevenueCycleManagement #ZapareTechnologies #CareerOpportunity,

Posted 1 month ago

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SME - Denial Management Zapare Technologies

2.0 - 3.0 years

4 - 5 Lacs

Kochi, Ernakulam, Thrissur

Work from Office

Designation: SME - Denial Management Experience: 2-3 years Skills desired: Detailed knowledge of US healthcare billing cycle Experience working with different EMR/EHR systems like Epic, Cerner, Allscripts, Athenahealth, NextGen, eClinicalWorks, Meditech, etc. Denial analysis and management - Review and analyze denied insurance claims to identify cause of denials such as coding issues, preauthorization, payer-specific policies - Develop and track denial log to monitor patterns and trends in denied claims - Experience talking with payers to obtain clarification with denials and initiate timely appeals when appropriate Expertise in working with denial reason codes (CARC, RARC) and identifying root causes of denials. Strong understanding of billing regulations, CPT, ICD-10, HCPCS codes, and compliance standards (HIPAA, CMS guidelines). Appeals - - Understand 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP - Prepare, submit, and follow up on appeals ensuring all necessary documentation is included - Revie Review assigned denials and EOBs for appeal filing information. Gather any missing information - Review case history, payer history, and state requirements to determine appeal strategy - Obtain patient and/or physician consent and medical records when required by the insurance plan or state - Gather and fill out all special appeal or review forms - Create appeal letters, attach the materials referenced in the letter, and mail them Maintain a record of all appeals and responses to track appeal outcomes and recovery rates Monitor payer response timelines to ensure appeal filing deadlines are met Track insurance company and state requirements and denial trend changes

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